Blood test may miss statin-related muscle injury: study

From CBC News:
Muscle damage related to the use of statins is not uncommon, but now researchers say tissue classified as injured by the cholesterol-lowering drugs can't always be detected through a standard blood test.

Studies suggest 10 to 15 per cent of people taking statins experience some kind of muscle pain or weakness as a side effect of the treatment. A smaller but unknown percentage have stronger, persistent pain, called myopathy.

If doctors suspect statins are causing pain, they usually test for an enzyme in the blood known as creatin phosphokinase (CPK), which leaks from damaged muscles.

But a study by U.S. and Swiss researchers published in the July 7 issue of the Canadian Medical Association Journal found muscle damage even when tests came back negative for elevated levels of serum CPK.

The researchers looked at leg muscle biopsies from 44 people who had "clinically diagnosed statin-associated myopathy" and were either currently taking statins or had recently taken them.

They found that 25 of those patients also had muscle injury, in spite of normal blood tests. Only one patient with "structural injury" had a circulating level of creatine phosphokinase that was elevated more than the upper limit of normal, the researchers said. ...more

Study on cholesterol drugs raises ethical questions

From the Calgary Herald:
Quebec doctors are being offered $100 for every new patient they put on cholesterol-lowering statin drugs as part of a major, federally subsidized study that's raising questions about the influence of the pharmaceutical industry on health research.

Critics say the OBSTAT trial seems more about drug marketing than science, getting thousands more people to take an already popular medicine.

Statins are among the most successful medications in history, with Lipitor — Canada's top-selling prescription drug — racking up almost $1.4 billion in national sales in 2008. There is ample evidence that, by cutting levels of blood cholesterol, they lower the risk of heart attacks and strokes in people already diagnosed with cardiovascular disease.

Whether they work well as primary prevention — for people who have high levels of cholesterol but don't have heart disease yet — is more debatable, though millions of such patients are taking them.

Considered relatively safe, the drugs can nevertheless cause muscle pain — sometimes severe — and other side effects. ...more

Kids' cholesterol pills worry MDs

From the Vancouver Sun:
Canada's top medical journal is warning doctors about giving cholesterol pills to children, saying there is scant direct evidence statins are safe for children and that doctors risk committing kids to "decades of therapy."

Millions of Canadian adults take the cholesterol reducers to lower their risk of heart attacks and cardiovascular disease.

Now, the American Academy of Pediatrics says the drugs should be considered for children as young as eight who have high concentrations of LDL, or low-density lipoprotein, the "bad" cholesterol.

But a leading editorial in this week's Canadian Medical Association Journal says statins haven't been widely tested in children, most studies involved kids whose high cholesterol is due to an inherited blood disorder -- not obesity -- and that only one study followed children for more than a year. ...more

Kids' cholesterol pills worry MDs

From Canada.com:
Canada's top medical journal is warning doctors about giving cholesterol pills to children, saying there is scant direct evidence statins are safe for children and that doctors risk committing kids to "decades of therapy."

Millions of Canadian adults take the cholesterol reducers to lower their risk of heart attacks and cardiovascular disease.

Now, the American Academy of Pediatrics says the drugs should be considered for children as young as eight who have high concentrations of LDL, or low-density lipoprotein, the "bad" cholesterol.

But a leading editorial in this week's Canadian Medical Association Journal says statins haven't been widely tested in children, most studies involved kids whose high cholesterol is due to an

inherited blood disorder -- not obesity -- and that only one study followed children for more than a year.

The journal calls it the latest example of "age indication creep" -- giving drugs approved for adults to kids. ...more

When it comes to statins, don't believe the hype

From the Globe and Mail:
The headlines were dramatic and unequivocal:

"Cholesterol drug causes risk of heart attack to plummet" - Fox News.

"Cholesterol-fighting drugs show wider benefit" - The New York Times.

"Cholesterol drug cuts heart risk in healthy patients" - The Wall Street Journal.

The New York Times article summarized the exciting news in a front-page story saying that "millions more people could benefit from taking the cholesterol-lowering drugs known as statins."

That's big medical/business news, because statins are already the bestselling drugs in the world, with sales in excess of $20-billion (U.S.).

Quoting some of the world's top heart researchers, media reports touted the importance of a blood test for C-reactive protein. That's because those benefiting from statins had high levels of CRP (a marker for inflammation) rather than high levels of LDL cholesterol, which is usually the criterion for statin prescription. ...more

Breakthrough study finds simple blood test may detect heart disease

From the Globe and Mail:
Measuring certain proteins through a simple blood test may make heart disease easier to detect and a lot less deadly, according to a study published online Sunday in the New England Journal of Medicine.

People with healthy LDL-cholesterol levels but elevated levels of high-sensitivity C-reactive proteins experienced a nearly 50-per-cent reduction in the risk of heart attack, stroke, and cardiovascular death with a daily dose of a cholesterol-lowering statin drug, the study found.

The reduction in heart-disease risk among people who appear healthy and lack risk factors such as elevated cholesterol – which describes about half of those who experience heart disease – is such a significant finding that the drug trial was cut short in order to publish the results sooner.

The nearly 18,000 patients followed in the study had normal cholesterol levels and slightly elevated levels of C-reactive proteins – markers of inflammation that are known indicators of atherosclerosis, or blockage of the arteries.

The researchers suspected statin medications such as rosuvastatin would lower the risk of cardiovascular events in such patients, whose LDL-cholesterol levels were below 3.36 millimoles per litre, but were surprised by how well they worked. ...more

Statins: the Aspirin of the 21st century?

From CBC News:
They're the best-selling family of drugs of all time, with annual worldwide sales estimated at more than $20 billion. Every year, Canadian doctors write more than 12 million prescriptions for statins, making them the most-prescribed drugs in the country. They're in a class of drugs that has proven very effective at lowering cholesterol levels and reducing the risk of heart attacks.

The possible effectiveness of statins is so great that surprised researchers reported in November 2008 they have stopped a four-year study two years early in order to present their findings as soon as possible on the drugs' benefits to patients.

The study, which followed nearly 18,000 patients from 27 different countries, found the strongest evidence yet that people with high levels of a particular protein are at increased risk of cardiovascular disease. It also found that the risk dropped by nearly half for patients treated with statins.

All the patients had normal levels of cholesterol (LDL-c) and high levels of hs-CRP (high-sensitivity C-reactive protein) — previously suspected, but not confirmed, to be a critical indicator of heart problems — and as such were not receiving any treatment for cardiovascular disease. ...more

A New Age Of Statins?

From Forbes:
A new study could lead millions more Americans to take cholesterol-lowering drugs and generate billions in sales for AstraZeneca, which funded it. But first comes a furious debate.

The study, called Jupiter, gave either AstraZeneca's Crestor or placebo to 18,000 patients who received bad scores on a little-known blood test for C-reactive protein (CRP) that is thought to measure inflammation in the arteries. Patients who took Crestor were half as likely to have heart attacks, strokes or operations to open clogged arteries as those getting placebo, an effect that ranks among the best results seen with the two-decade old class of cholesterol drugs called statins, of which Crestor is the most potent.

"It takes prevention to a new level because it applies to a whole group of patients who would not get a statin today," says Douglas Weaver, president of the American College of cardiology. In a statement, Elizabeth Nabel, head of the National Heart, Lung and Blood Institute, says adding CRP tests to those for blood pressure and cholesterol "could identify millions more adults for whom treatments with statins appears to lower the risk of heart attack." ..more

Statin use in seniors linked to higher risk of delirium after surgery

From CBC News:
Elderly people who take cholesterol-lowering statins may be at higher risk for delirium after surgery, say Canadian researchers who suggest temporarily stopping use of the drugs before surgery to prevent the complication.

People over 70 commonly show delirium or confusion after elective surgery, such as to repair hip fractures. Doctors now recognize delirium as a complication that should be prevented, recognized and treated.

Delirium not only causes anxiety for patients and their families, it also contributes to longer hospital stays, prolongs the need for intensive care and may disrupt or delay care, the researchers said.

In Tuesday's issue of the Canadian Medical Association Journal, Dr. Donald Redelmeier of Ontario's Institute for Clinical Evaluative Sciences and his colleagues concluded the use of statins is associated with a 28 per cent increased risk of delirium in elderly patients who had surgery between 1992 and 2002.

To come to that conclusion, the researchers reviewed hospital and outpatient pharmacy records of more than 280,000 patients aged 65 or older who were admitted for elective surgery.

Among the seven per cent of patients taking statins, 3,195 experienced delirium after surgery, the researchers said. ...more

Keep taking statins after heart attack: study

From Reuters:
People who are tempted to quit taking their statin medication because it failed to prevent a heart attack should think twice, Canadian researchers said on Wednesday.

They said heart attack survivors who stopped taking the cholesterol-lowering drugs were more likely to die during the following year than those who had never been on the drugs.

The findings, published in the European Heart Journal, underscore the effectiveness of the drugs, which not only reduce levels of low-density lipoprotein or LDL, the so-called bad cholesterol, but may also reduce inflammation.

Dr. Stella Daskalopoulou and colleagues at McGill University studied data on British patients who had survived a heart attack and were still alive three months later.

"Patients who used statins before an AMI (heart attack) and continued to take them after were 16 percent less likely to die over the next year than those who never used them," Daskalopoulou said in a statement. ...more

Some people taking cholesterol-fighting statins splitting pills, saving money

From the Canadian Press:
A small but growing percentage of British Columbians who take statins to lower their cholesterol have twigged to the fact that they can save on their medication bills by pill splitting, a new study suggests.

While the researchers only looked at records for statin prescriptions filled in British Columbia, they suggest substantial savings could be made by individuals who pay for their own drugs, by private or government-run drug plans or a combination of the two if the technique were more widely used.

"There are a lot of patients out there who are taking statins who ... could save a lot of money by splitting a larger tablet, or perhaps even moving to a lower cost statin and splitting a larger tablet of that statin and save even more money," said Colin Dormuth, an analyst in the University of British Columbia's Therapeutics Initiative and lead author of the study.

"There's a lot more potential for splitting to occur." ...more

Some kids should be on cholesterol drugs: study

From CTV News:
Children eight years of age or older should be treated with cholesterol medication if they are found to have high levels of low-density lipoprotein (LDL), or so-called bad cholesterol, a new report says.

The new recommendation from the American Academy of Pediatrics is a drastic step toward preventing cardiovascular disease among at-risk children, including those with high cholesterol.

CTV medical consultant Dr. Marla Shapiro said the recommendation to medicate kids with cholesterol drugs should not come as a surprise, given the dramatic rise in obesity among children.

"We're at the point where a large, respected pediatric society, which happens to be the American Pediatric Society, is taking a stand and really saying that with the rising epidemic of obesity, we know that in youth and young children this will translate into premature heart disease and stroke in the years to come," Shapiro told CTV Newsnet. ...more

Take statins, almost all diabetics are urged

From the Montreal Gazette:
Almost all of the more than 2 million Canadians with diabetes should be taking cholesterol-lowering drugs, according to a major new study.

Researchers who pooled data from 14 studies involving more than 90,000 people say cholesterol reducers known as statins lower the risk of heart attack and stroke in people with diabetes by about one-third - even in those whose risk of a major "vascular event" is as low as one per cent per year.

Reporting today in the journal The Lancet, researchers say their study shows "convincingly" most people with diabetes should consider taking statins.

"I know it sounds drastic but this is a group of people we can't be complacent about," says Colin Baigent, a professor of epidemiology at the University of Oxford and a member of the Cholesterol Treatment Trialists' Collaborators. ...more